A mixed-methods evaluation of the indoor and outdoor smoking ban in dining venues in Armenia: Early successes and challenges

INTRODUCTION Since March 2022, Armenia introduced a comprehensive smoking ban on all types of tobacco products in indoor and outdoor areas of hospitality venues. We aimed to rapidly appraise the implementation of the ban in the dining areas of the capital Yerevan and explore any differences in compliance and enforcement patterns between indoor and outdoor areas of the venues. METHODS We used a mixed-methods approach through quantitative air quality monitoring, qualitative observations, and in-depth interviews (IDIs). We visited one venue in each remote district of the city and more venues from the central districts that have a much higher density of dining areas. Overall, we made 24 measurements of PM2.5 particles, 24 unobtrusive observations in the 19 visited venues, and 11 IDIs with six visitors and five workers. We used Stata13 for the analysis of numerical data and completed direct deductive content analysis of the textual data. RESULTS Active tobacco use was observed in 12 out of 24 venues (50.0%) with more cases of smoking in outdoor areas (10 out of 12; 83.3%). No warning by workers or no reports to the police were observed. We detected elevated levels of PM2.5 particles in indoor and outdoor areas. The IDIs revealed predominantly negative attitudes towards the outdoor ban and the lack of awareness of and readiness to engage in the enforcement measures. The lack of enforcement by the owners and the respective bodies was mentioned as a contributor to continued violations of the ban. The change in the dynamic and the characteristics of the visitors, cleaner air, and less unpleasant work were mentioned as important positive aftermaths of the ban. CONCLUSIONS The Government of Armenia should enhance the monitoring and enforcement activities and organize tailored awareness-raising campaigns to inform the general public and the hospitality industry of the health and social implications of the ban.

• Any external factor such as financial penalty or signage of "smoke-free area"?
• Please name any other factors that can assist implementation of the law. V.

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How long have you been working in this café/restaurant?• How do you feel about being exposed to secondhand smoke while working in this venue before the smoke-free legislation in hospitality venues entered into force?And what about now?Now let's go into details about the smoking ban in hospitality venues and your knowledge and experience regarding that ban.Do you know what you have to do in that scenario as per the law?14) In case if any of your visitors ask you for ashtray, would you bring one for them?Please elaborate why yes or no.Since the law has been implemented, what kind of changes in smoking practices have you noticed in your visitors?Was the new policy easily accepted by them?16) Do the visitors of your venue comply with the law?In your opinion, what are the reasons that the visitors comply with the new smoke-free law?For example, because your venue is 100% smoke-free?What else?And what are the factors that challenge their compliance?17) Could you also tell what can help the visitors to be more compliant with the smoke-free law?
I. Knowledge of the smoke-free law 1) What do you know about the new smoking ban that was enacted starting March 15, 2022?Can you describe the ban and its purpose (establish and maintain smoke-free environments)?How did you learn about it?II.Attitude of the smoke-free law 1) What do you, generally, think about the new smoking ban in indoor and outdoor areas • Did the guest stop smoking after your notice or not?• What did you do when the guest did not agree to stop smoking even after you gave them a notice?• What is the difference between indoor and outdoor areas?And what is the reason?• Do you know what you have to do in that scenario as per the law?12) What type of tobacco products are being used in indoor areas?What about outdoor areas?13) If you ever see a guest who is smoking, what will you do?Would you approach them and ask them to stop smoking?• What would you do if the guest does not agree to stop smoking even after you gave them a notice?•

VI. Knowledge of the smoke-free law
to improve the enforcement 18) Based on your recent experience, what are the factors that help the workers to enforce the new smoke-free law?Could you please also name the factors that challenge the workers in enforcing the new smoking ban? 19) Now please name the factors that can further motivate the workers or help them to more effectively implement the enforcement of the law?20) What do you think about calling police and notifying about violation in your venue?What do you think about the financial penalty as a mean for enforcement of the smoking ban?Are those effective?Have you ever turned to those means for supporting the enforcement?Why yes or why not? 21) Do you have any suggestions on how to improve the current situation with the enforcement of the smoke-free law? 1. Could you tell me what do you know about the new smoking ban that was enacted starting March 15, 2022?Can you describe the ban and its purpose (establish and maintain smoke-free environments, improve health of workers and visitors)?How did you learn about it?What do you think, is having smoking ban in indoor and outdoor areas important?4. What do you think are those bans voluntary or mandatory?Please explain.In what situation it is mandatory and in what situation it is voluntary?What are the advantages and disadvantages of mandatory smoking bans? 5. Please comment on whether it is too strict or it is reasonable to have both indoor and outdoor smoking bans.Please elaborate.6.What are/will be some potential positive effects of indoor and outdoor smoking bans in Have you noticed any change in workers' behavior in terms of enforcing the law in hospitality venues?Please specify.
Appendix 2: Interview Guide for visitors of hospitality sectorThank you very much for agreeing to participate in this study.Let's start the interview by talking about your interest regarding this venue: • How often do you come to this café/restaurant?• What do you specifically love about this place?• Do you usually come here with your friends/ family or alone?• When you come to this café/restaurant how long do you approximately stay here?Now let's go into details about the smoking ban in hospitality venues and your knowledge and experience regarding that ban.IX.

Their attitudes towards the protective nature of the law 8
. Since the law has been implemented, what kind of changes in smoking practices have you noticed in other visitors?What about decrease in the use of tobacco products -have you noticed such trend?What is the difference between indoor and outdoor areas?And what is the reason?• Do you know what you have to do in that scenario as per the law?11.What type of tobacco products are mostly being used in indoor areas?What about outdoor areas?12. Have you ever noticed a worker to bring an ashtray to visitors per their request?13.What would you do in case of noticing an ashtray on the table or smell of smoke in hospitality venue?14.If you ever see a guest who is smoking, what will you do?Would you approach them and ask them to stop smoking?• What would you do if the guest does not agree to stop smoking even after you gave them a notice?• Do you know what you have to do in that scenario as per the law?

X. Suggestions on how to improve the enforcement 15
. What are the factors that help the workers to enforce the new smoke-free law?Could you please also name the factors that challenge the workers in enforcing the new smoking ban? 16.Can you name factors that can help other visitors to become more complaint with the smoking ban? a.Any external factors such as penalty or postage of "No smoking" sign.b.Please name other factors, that can help the implementation of the law.17.Now please name the factors that can further motivate the workers and other to more effectively implement the enforcement of the law?18.What do you think about calling police and notifying about violation in your venue?What do you think about the financial penalty as a mean for enforcement of the smoking ban?Are those measures effective?Have you ever turned to those means for supporting the enforcement?Why yes or why not?What can be done in this regard?19.Do you have any suggestions on how to improve the current situation with the enforcement of the smoke-free law?